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Hepcidin predicts 5-year mortality after community-acquired pneumonia
Kjersti Oppen1,2,3, Thor Ueland2,3,4, Annika E Michelsen2,3
1Department of Laboratory Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
Background:
Virtually all living organisms, including microbes and humans, depend on iron to survive and grow. During an infection, the plasma level of iron and several iron-related proteins change substantially. We hypothesized that iron and iron-related proteins could predict short- and long-term outcomes in community-acquired pneumonia.
Methods:
Blood samples from a prospective cohort of 267 in-patients with community-acquired pneumonia were analysed for hepcidin, ferritin, iron, transferrin, transferrin saturation, and soluble transferrin receptor at admission and 6-weeks post-discharge. Adverse short-term outcome was defined as admission to intensive care unit or death within 30 days, and long-term outcome was assessed as 5-year overall mortality. Logistic regression, Kaplan Meier survival curves, and Cox regression models with cut-offs at median for the potential biomarkers were used for statistical evaluation.
Results:
Low admission levels of hepcidin predicted 5-year overall mortality, independently of age, sex, comorbid conditions, and anaemia. Low levels of ferritin at admission as well as low levels of iron and transferrin saturation and high levels of soluble transferrin receptor at the 6-week follow-up were predictors of 5-year overall mortality in univariable, but not in multivariable analyses. Neither of these potential biomarkers predicted adverse short-term outcomes.
Conclusions:
In hospitalized patients with community-acquired pneumonia, low levels of hepcidin at admission predicted 5-year overall mortality, but not short-term adverse outcome.
Insights
Low hepcidin levels at hospital admission can predict long-term mortality in community-acquired pneumonia patients. This iron-related biomarker did not predict short-term adverse outcomes in the study.
Area of Science:
- Biochemistry and Molecular Biology
- Infectious Diseases
- Clinical Medicine
Background:
- Iron is essential for microbial and human life, with vital roles in cellular processes.
- Plasma iron and related protein levels fluctuate significantly during infections.
- Understanding iron's role in community-acquired pneumonia (CAP) may offer prognostic insights.
Purpose of the Study:
- To investigate the predictive value of iron and iron-related proteins for short- and long-term outcomes in CAP.
- To assess hepcidin, ferritin, iron, transferrin, transferrin saturation, and soluble transferrin receptor as potential biomarkers.
Main Methods:
- Prospective cohort study of 267 hospitalized CAP patients.
- Analysis of hepcidin, ferritin, iron, transferrin, transferrin saturation, and soluble transferrin receptor at admission and 6-week follow-up.
- Statistical analysis using logistic regression, Kaplan Meier curves, and Cox regression models.
Main Results:
- Low admission hepcidin levels independently predicted 5-year overall mortality in CAP patients.
- Low ferritin, iron, and transferrin saturation, and high soluble transferrin receptor at follow-up predicted mortality in univariable analysis only.
- None of the assessed biomarkers predicted adverse short-term outcomes (ICU admission or 30-day mortality).
Conclusions:
- Hepcidin levels at admission are a significant predictor of long-term mortality in hospitalized CAP patients.
- Iron-related biomarkers do not appear to predict short-term adverse outcomes in CAP.
- Hepcidin shows potential as a prognostic marker for long-term survival in CAP.
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